Peritoneal Pull Through (PPT)
How is a PPT vaginoplasty different from a penile inversion vaginoplasty?
Instead of using skin from the penis and scrotum to line the vagina, this surgery uses a thin layer of tissue from the underside of the abdomen called the peritoneum. To get this tissue, we perform a minimally invasive robotic surgery through 5 small (<1cm) incisions in the abdomen.
What are the benefits of a PPT vaginoplasty?
Though this surgery has been performed for many years for cisgender women born without a vagina, it has only recently been used for transgender and nonbinary patients. Therefore, there are no long term data on the outcomes of this surgery for these patients. Usually, we can get 2-3 additional centimeters of vaginal depth in surgery compared to penile inversion vaginoplasty, although final depth for this procedure is variable. Also, it seem as though the peritoneal lining has a lower chance of scarring down compared to skin, but still requires lifelong dilation. The lining also produces a natural lubrication for some patients. Another added benefit is that hair removal is not required for the vaginal lining as the lining is fully peritoneal. Penile inversion technique even after hair removal treatments and follicle scraping, occasional dormant or resilient follicles can sprout hair from skin grafting inside the vagina. Peritoneal lining does not have any hair follicles. ( Hair removal is recommended for the labia minora preop but is not required as hair removal is still possible postoperatively, although the follicles may be harder to access in some folds- please see modified hair removal guide for PPT.)
Are there extra risks to a PPT vaginoplasty?
Compared to a penile inversion vaginoplasty, the PPT procedure requires an abdominal surgery which has additional risks of bleeding, infection, and injury to things like the bowel and bladder. However, it is likely safer than colon vaginoplasty because of the risks associated with removing a portion of bowel. If a PPT vaginoplasty is performed and the vagina scars closed, then the recommended option of regaining depth would be colon surgery. Also, the amount of discharge can be bothersome for some patients and it may require that you wear a thin underwear liner to absorb the moisture.
Who can get a PPT vaginoplasty?
This surgery can be a great option for patients whose other options are limited to including colon vaginoplasty. This includes patients needing revision surgery, nonbinary patients who do not want a penectomy, patients with trauma to area, not enough skin available from penile shaft and/or scrotal donor sites, patients who have been on puberty blockers and patients resistant to hair removal treatments. Patients can also choose to have a PPT vaginoplasty as their primary surgery if they understand and accept that there are no long term data on the outcomes of this surgery.
How long does the surgery take and how long will I stay in the hospital?
For a primary surgery, the procedure takes around 5 hours and patients stay in the hospital 2-3 nights. For a revision surgery, the procedure usually takes less time and patients go home the same day or possibly stay in the hospital for 1 night.
How can I learn more about my surgery options?
We would love to see you for a consultation appointment at MoZaic Care to talk about all your surgical options! Our clinic phone number is 415.395.9895 and we are located at the CPMC Davies Campus (45 Castro Street, Suite 324, San Francisco, CA 94114).
See the Vaginoplasty FAQs page for additional details.